7/12/2002

Jane Galt weighs in on my lengthy AIDS post. She finds several flaws in my argument, namely the following assumptions. Since her points are reasonably independent, I'll address them in turn.

It assumes that the drugs we use will work the same way in Africa, even though the major AIDS strain there is different from the one here.

I haven't heard that the AIDS strain is different, and definitely would be interested in the data demonstrating that. Jane is an economist and has an MBA, and I am a physics grad student doing Magnetic Resonance Imaging research, so neither of us has a real claim to authority on biochemistry. So I admit freely that what I'm about to state may be totally wrong and I invite corrections. From what I have read, it seemed to me that the AIDS virus operates by targeting our immune system in a specific way. So it isn't obvious to me that the drugs would not have any effect.

Since the virus here in the US has been aggressively targeted, it has presumably mutated in response. Whereas in Africa, where the virus originated, it has been effectively left alone without much need for evolutionary defensive mutations. So if anything, I believe that AIDS drugs would potentially be more effective there.

It is all speculation of course - both Jane's critique on this point and my response. I just don't see this issue as a practical concern. I would love to have any biochemistry-types out there to weigh in on this, though. Please email me...

It assumes that education will have the same effect there as it did here (although given that AIDS education is only apparently about 50% effective here, and unsafe behavior seems to be -- anecdotally -- on the rise again with the advent of the "cocktails", that may not be enough of a goal to shoot for)

Again, I don't know where the 50% statistic comes from, so in all fairness I have to discount it. But the main point, that we cant assume that education will have the same effect, seems borderline insulting. Why wouldn't education be effective? What is different about the mental capacity of a African as compared to an American homosexual ? (yes, I'm comparing a racial group to a social group, so its apples and oranges). My point is that education is education. And it must be made part of any plan to treat the problem of AIDS. It isnt a silver bullet by any means, of course, but there's no reason to say it won't have any effect.

It assumes that a disease vectored primarily through heterosexual sex will respond to education and/or treatment the same way as one vectored primarily through homosexual sex and blood-to-blood contact.

Hmm. Treatment is a biological issue, we have already addressed that in Point 1. Education is presumably tailored to how the disease is vectored, clearly we won't be putting as much emphasis on homosex as opposed to the dangers of unprotected heterosex. It's obvious that education must be tailored to the problem and is not one size fits all. This is really the same thing as Point 2 above. There isnt a new critique here, just a combination of the previous two.

Most of all, it assumes that the drugs we send can be administered in Africa the same way they are here. I'm sorry, I just don't see it. Roads. Clinics. Electricity. Health care workers. Education, to believe that little bugs you can't see can really make you sick. (Don't snicker. It took your ancestors a hundred years to believe it.) Population density. Attitudes about sex. Look at where AIDS campaigns are working -- Southeast Asia and America/Western Europe, both with relatively shame-free attitudes about most sorts of sex, both with high levels of population density and a functioning health care infrastructure, both with compact high-risk populations that could be targeted and identified.

This is the meat of Jane's argument and the point on which I agree with her (in broad outline). The infrastructure is shockingly bad. But it is NOT non existent, either. I have friends living in Nairobi, Mombasa, and Durban, and friends who hail from small villages in Kenya and Zaire and Zambia. A lot of my family has traveled to Africa also. From all accounts, it isn't the primitive backwards wasteland that it has been portrayed as in our collective sterotyping unconcious. They actually DO have roads, clinics, electricity, and health care workers. They are just pathetically, even criminally underfunded. Africans (with teh possible exception of Thabo Mbeki) DO understand that little bugs make you sick, they are capable of comprehending the education needed to change behaviors. The culture is relatively shame-free about sex (let me tell you btw, southeast asia is pretty prude in comparison) but there is the problem of misogyny and the position of women is not that great. Education, especially for women, can do a great deal.

In fact, this underscores the point I was trying to make in that we need a broad-based approach, based on pragmatic realities such as Den Beste originally pointed out and Jane has also illustrated above. The AIDS epidemic needs to be attacked on the symptoms and the root causes. The symptoms can be controlled with drugs, the root cause with education. We dont have unlimited supply of money, so the approach pioneered by Brazil is essential - manufacture the drugs locally for cheap (yes, it is cheap. and yes, African countries do have the manufacturing and technical knowledge). This saves money which can instead be spent on education, tailored to the culture and the specific manifestation of the epidemic, which is indeed not the same as it is in the US.

My complaint with the standard approach is that it inverts the problem. The UN wants 68 billion to pay mostly for drugs at market price (outrageous!) and then basically import AIDS education materials verbatim from San Francisco for cheap. The money needs to be freed to be targeted at education instead, and the drugs are NOT a financial obstacle at all.

I wish that more attention in the blogsphere would be drawn to the issue of compulsor licensing and eminent domain. That's the real key.